Sarah Myhill is a UK-based physician with a special interest in nutrition and fatigue. Her groundbreaking studies demonstrating mitochondrial failure in ME/CFS - and present trials of nutritional approaches to offset the effects - position her as a leading researcher in the field. See her educational website (DrMyhill.co.uk) for much more.

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Rheumatic Patches: A Common Cause of Inexplicable Pains

Dr. David LJ Freed (MB, MD, MIBiol; a UK-based Allergy, Environmental and Nutritional physician) was the expert on rheumatic patches and this page explains his work. [For much more detail, see Dr. Freed’s patient handout on “Rheumatic Patches” and how intolerance of dietary lectins may drive their development. Though Dr. Freed passed away recently, his allergy clinic remains very active.]

A rheumatic patch is a sensitive patch of skin (and superficial connective tissue under the skin) which hurts when gently pinched. They are most often found over the scalp, neck and back but can be present anywhere in the skin.

There is a real pathology there too – haphazard collagen bundles, fewer hair and sweat glands with infiltration by white cells. Look for them yourself by gently picking up an “as shallow as possible” fold of skin and squeezing it between your fingers.

Occasionally there are tiny thread veins of skin tags associated with rheumatic patches. People don’t know they have them until they look for them.

Osteopaths, chiropractors, acupuncturists, etc. all know about them and treat rheumatic patches, but probably call them something else! [Perhaps including Guaifensin Protocol developer Dr. R Paul St. Amand, who locates and ‘maps’ such nodules in his physical exams of fibromyalgia patients.]

What is so important about rheumatic patches is that they are often misdiagnosed as something else – prolapsed disc, cervical spondylosis, sciatica, sacroiliac strain, fibrositis, fibromyalgia, neuralgia, stiff neck, whiplash injury, repetitive strain injury, even plantar fasciitis. Even migraine can be associated with rheumatic patches in the scalp.

Dr. Freed suspects the rheumatic patch is the earliest lesion of arthritis.

Most patients with established arthritis have pain for years before they have serious joint problems or X-ray changes. If rheumatic patches are treated at an early stage, progression of arthritis can be halted.

The rheumatic patch is an area of “stiffness” in the skin.

One feature of stiffness which the structural engineers tell us about is that lines of force tend to be concentrated through stiff patches, which makes these areas vulnerable to mechanical stress.

Thus any structural imbalance in the body for whatever reason, (lopsidedness, poor posture, muscle strain etc) concentrates stress lines through the stiff patches - and causes pain. A dowager’s hump is a typical large rheumatic patch.

The main symptom is pain but one may also experience itch, twitch, “ants crawling,” parasthesia (burning, tingling, prickling) or even restless leg symptoms.

The trigger points of fibromyalgia are also rheumatic patches.

Indeed, to diagnose fibromyalgia there are 18 trigger spots that are looked for, mainly on the upper body; i.e. neck, shoulders, and chest, because this is where the lines of force are and the tissue and skin of the body “hangs” off the skeleton.

Treatment of Rheumatic Patches

This is tackled by:

1. Preventing the Stiff Area of the Skin from Being There at All.

• One cause of stiff areas is food intolerance, possibly intolerance of lectins. Lectins are natural plant toxins, the main sources of which are wheat and other grains, beans, and nightshade vegetables. [Dr. Freed suggested that lectins, which are not easily digested, may enter the bloodstream through the lining of the gut (perhaps owing to a lack of gut flora that support lectin-protective substances) and bind strongly to the connective tissues and skin. This is because lectins have an affinity for monosaccharide N-acetyl-glucosamine (GNAc), a sugar found in considerable quantities in these tissues.]

Such an intolerance may be triggered by an acute viral infection. [For example, Dr. Freed noted that a common trigger for a relapse of rheumatism and arthritis is an attack of flu virus. And the flu virus contains a surface enzyme that makes cells more susceptible to binding by lectins.] Indeed, the old advice of “starving a fever” may have been useful in preventing rheumatic patches from developing. However, some patients have specific food allergies.

• Magnesium deficiency is another possible cause, as is essential fatty acid imbalance.

• Doing the Stone Age diet (emphasis on protein, fat, vegetable fiber, low on common allergens). This alone may cure the problem.

• Improving posture, muscle tone and balance (rheumatic patches are very rare in athletes and gymnasts) – see a good physiotherapist or osteopath.

• Dr. Freed treats rheumatic patches by injecting the skin with a dilute solution of salicylic acid. Whilst this is undoubtedly effective, it really is a first aid measure and the effects are not long lasting.

I always like to think “causation” and “mechanisms.” Rheumatic patches are all about the connective tissue or fascia that links skin to muscles and then runs into tendons and bones. The raw material that makes this is the same but what differs is the level of stiffness or stickiness of that tissue.

I am amazed by how extraordinary skin is – elastic, tough and pliable. How does connective tissue stick with just the right degree of stickiness? Connective tissue is electrically alive – physically it is a colloidal gel, and fascia is the fuzz that holds things together.

I do not know but my guess is that this stickiness is electrochemical rather than physical. It may be that what we perceive to be muscle stiffness is in fact connective tissue stiffness. The muscle stiffness is a reflex to protect us from tearing the connective tissue when it is too sticky. See “Muscle Stiffness.”

This may explain why Epsom salt (magnesium sulfate) spas and baths have stood the test of time with a long history of improving arthritic lesions. Anyone with arthritis could benefit from a daily bath with 500grams (one pound) of Epsom salts dissolved and a 15 minute soak.

Note: This information has not been reviewed by the FDA. It is for general information purposes only; is not meant to replace the personal attention of a medical doctor; and is not intended to prevent, diagnose, treat or cure any condition, illness or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

There's a bad error in the article. Trigger points and fibromyalgia tender points are very different things! It is possible to have trigger points in the skin (as opposed to the more common myofascial trigger points), which may be the same thing as this concept, though it is more commonly associated with surgery scars.